Palliative Care and Hematological Malignancies: Increased Referrals at a Comprehensive Cancer Centre

Background: Current evidence indicates that patients with hematological malignancies are less likely to receive input from specialist palliative care services compared to those with solid tumors. Aim: We aimed to analyze data for referrals to our palliative care service, in order to assess trends in the number and proportion of referrals received from hematology, and changes in the characteristics of these referrals. Design: Prospective information was collected for all referrals to the Department of Pain and Palliative Care (DPPC) over a four-year period. This included inpatient/outpatient status, diagnosis, symptoms, and goals of the referring clinician; and information linked to hospital inpatient data to obtain date and location of death. Settings/Participants: All hematology referrals were from January 2007 to December 2010. Results: Hematology referrals constituted 11.6% of all referrals received during the study period. Outpatient referrals increased significantly with each year, as did the proportion of patients referred for symptom control. The median time from referral to death was 34 days, with poorest survival seen in acute leukemia and inpatients. Overall, 54% of inpatient hematology deaths had consultation from the DPPC, with these patients less likely to die in the intensive care unit. Conclusions: Over recent years, collaboration between hematology and palliative care has resulted in increased referral numbers, with potentially positive results for patients.